Study design The study will be conducted as a comparative, semi-blinded, matched one (according to sex, age and difficult airway - that will be assessed according to neck diameter and anatomical parameters). The setting will be the ICU of the Sourasky medical center. 60 consecutive adult critically ill patients who require elective tracheostomy will be recruited for the study. Informed consent will be obtained from the families or next of kin of all study patients. In the absence of relatives, consent will be given by an anesthesiologist/intensivist not related to the study. Both procedures will be performed by the same team of intensivists upon all study patients. During and following the procedure we will assess all of the parameters mentioned above.